Revision THR Continuing thigh pain from failed osteointegration?<

[chalcedonian1]

@TerryB_TX I think your instinct about the 3rd surgeon seems right. It sounds like he loves what he does (a trait my revision surgeon has) and he knows a LOT about options and choices, as well as the scholarly stuff. It sounds like you are well on your way. What you are doing now is really harder (the questioning, the research, the decision making, dealing with one's own uncertainties)--once you have the surgery you have no choice but to do what your body tells you to do with faith it will turn out right this time. The hospital sounds like a good choice too--I assume it has a good reputation in your area? You seem to be a very educated consumer of health services and you process the information given you in a very intelligent way. Keep us informed as to when etc. you will have this done, and I will continue to post updates should you care to read them.

@Josephine A famous hip surgeon at Mass General Hospital a couple of years ago accused other surgeons at that hospital of leaving the surgery room to perform surgery on another person "simultaneously"-- very good for billing, not so good for the patients. The admin of MGH denied this practice, fired the accusing surgeon, and the matter is now in litigation. Many of the hospitals in this area of MA are teaching hospitals, and interns/residents are allowed in to do more than observe. Patients are actually required to sign a release pre-surgery indicating that the patient consents to their presence and participation in certain parts of the operation as the surgeon deems appropriate. I add to this waiver that I want the major portions of the surgery to be performed by the surgeon I hire. Of course it is fine for others to observe and hand tools and such to the surgeon but I do not want to be a guinea pig, most especially in a revision situation! It is an abundance of caution. And as I said, New England Baptist is interestingly now making an affirmative representation in its literature that its surgeons only perform one operation at a time, which implies of course that residents (and other assisting surgeons) there are not left behind to do important parts of the surgery while the surgeon waltzes into another surgery. Crazy I know, but the litigation I mentioned will be even crazier with MGH if there isn't a settlement first.

@Mojo333 It is always better to be lucky than to be anything else, right?, so good on you that you landed an excellent surgeon with great results! I would not want anyone to repeat my experience if it could be avoided, that is for sure. Hope you are doing well.

 

[TerryB_TX]

I would agree with this 100%

Perfect! that reinforces my choice of surgeon #3 versus surgeon #2 who wanted to address the psoas irritation by removing and realigning the cup, even though it appears to be well integrated.

I don't agree. The mention of HO is simply enforcing the fact that NSAIDs can inhibit new bone growth. If it didn't, then why is it so effective for HO? Doesn't make sense!

I'm with you on this. I'm not taking chances this time around.

What makes you think that either would make you a test subject? Just curious ...

If the ceramic liner has only 10 or so years in widespread use, I'm less inclined to trust a claim that it has the same or longer life compared to other liners that have been in widespread use 25 or more years. That being said, I really don't know how long the current generation of plastic liners have been in use. I probably need to investigate this a bit more.

Thank you again for your very helpful and experienced guidance.

 

[TerryB_TX]

You seem to be a very educated consumer of health services

Ha! Let's just say I'm trying to become a more educated consumer of health services! It is so difficult in the U.S. to find useful, detailed, and unbiased data on health providers and institutions. Certainly better now than it was years ago. I will admit that I was naïve when I went into this hip replacement. My younger brother had just had his done and was raving about how great it was. I would overhear strangers talking about their positive experiences - "I was back out on the golf course in 6 months", and saying they wished they had done it earlier. I got a few recommendations from friends in the area, read a few reviews on Healthgrades, made a choice, and then dove right in. Even so, I don't think I made a bad choice. All the revision surgeons I spoke to had good things to say about my first surgeon. At least two of them I believe to be sincerely held opinions. Even the surgeon I plan to use for the revision said that he has had instances of loose stems. He said I may just be one of the unfortunate 1% of my original surgeon's patients with this outcome. One percent is not a bad failure rate, I guess. It's just so much more frightening when that 1% chance becomes 100% me.

 

[TerryB_TX]

Ok. I’ve searched and searched the forum for the article on different options for hip prosthetic materials - ceramic, plastic liners, etc. I know I’ve read the article here on BoneSmart, but now can’t find it. Would somebody be able to point me to it?

 

[Josephine]

If the ceramic liner has only 10 or so years in widespread use, I'm less inclined to trust a claim that it has the same or longer life compared to other liners that have been in widespread use 25 or more years.

ceramic liners have been in use for around 15 years and the incidence of problems have been minimal. There was a time, pre-2005, that they squeaked and occasionally suffered 'catastrophic shattering'. Both of these were fixed by altering the make-up of the material very soon after this was reported and none of these events have been reported since.

That being said, I really don't know how long the current generation of plastic liners have been in use.

High Molecular Weight PolyEthylene (HMWPE) has been in use since 1975 but it was later changed to Ultra High Molecular Weight PolyEthylene (UHWMPE) which is even more durable. In the last 10 years, they have even impregnated the plastic with Vit E which apparently locks the molecular chains together for even more durability!

There are reports here of people with hips that have lasted an even greater period of time
Hips that have lasted 32, 40, 41 and 45 years
67½ year old - the THRs, not the patient!

Hope this reassures you!

 

[TerryB_TX]

Hope this reassures you!

Yes, thank you! It seems like there’s no significant difference in performance or longevity between the liner options this surgeon is offering to me. If that’s the case, I’m inclined to let him go with his preference. I have no basis for preferring one over the other.

 

[Jamie]

@Jamie , thank you so much for your help in providing me the list of revision surgeons. I don't know what I would have done without you. It would certainly have been a much longer, more stressful, and agonizing process on my own. I'll forward to you my feedback on each of the surgeons in a PM. Hopefully somebody else can benefit.

I'm so glad to hear that my recommendations were helpful! I very much appreciate your feedback and will look for your PM. Of course, I'll also be watching to see how your surgery goes as well. We really value the opinions of our members to help us with our surgeon recommendations.

It seems like there’s no significant difference in performance or longevity between the liner options this surgeon is offering to me. If that’s the case, I’m inclined to let him go with his preference. I have no basis for preferring one over the other.

I think this is a wise decision. You have a great surgeon who has earned your confidence by providing you with extensive details about your particular situation and how he plans to fix things. I'd say let him make the best choice for you. As Jo says, quite a number of our members have ceramic components and they are very reliable.

 

[TerryB_TX]

Just a quick update on my status...
I have a revision surgery date scheduled for August 20. Yesterday, I got the results of my July 25 needle aspiration test for infection and it was negative (yea!). I have one more meeting with the revision surgeon on Aug 14.
I'm now feeling more positive than I have in a long, long time. I'm trying to keep all the visions of potential bad outcomes locked away and out of mind. They do rear up every once in a while, but not nearly as often. I know it will probably be several more months before I'm fully convinced this surgery is a success, but I'm hopeful.

 

[Layla]

Hi @TerryB_TX
It's so great to hear no infection. Thank you for sharing.
It's difficult to keep our minds from going to the bad place sometimes.
We're all guilty of that. Try your best not to entertain negative thoughts. It's all you can do.
Stop by when you're in need of support, we'll be here to encourage and lift you in any way we can.
Wishing you peace and comfort as you await the 20th.

 

[Mojo333]

no infection!
A few more weeks and you can stay getting this thing back on track.
Happy you don't have a very long wait.
Eat well, stay well, think positive for sure!
Prayers for an uneventful recovery this time around!

 

[TerryB_TX]

Thank you for your kind thoughts and well wishes, @Layla and @Mojo333. I've now moved into training mode for my upcoming surgery. I've increased the time I'm swimming laps everyday, even started some light leg presses at the gym to help strengthen my legs. The revision surgeon said this would be ok, that it could loosen the stem further but that would make his removal job easier. He just warned me to pay attention to pain and back off if that increased.

I don't really know if any of that is necessary or helpful, but it at least makes me feel like I am participating in my own forward progress. I have a difficult time avoiding the negative thoughts. When I do, I feel like I'm moving back into denial. For me, doing something, anything, that contributes to my progress, no matter how slight, allows me to face the future with some sense of control. It's just my personal strategy for keeping the bad thoughts at bay. Thank you for reminding me how important that is. It really does improve my outlook.

 

[Mojo333]

Have you considered working mite in your upper body strength and your core.
I don't have any medical advice or know how you feel actually, but I would scared to get pushing my hip with a loose stem..especially if it is toggling against the bone.
You are handling things well..but please be oh so careful.

 

[TerryB_TX]

@Mojo333, You're absolutely right. I am trying to be very careful with my leg. Doing only very slight amount of weights and not very frequently...and I try to respect my body's pain signals. This activity is probably not enough to make any difference physically between now and my surgery, but it sure seems to help me mentally. Most of my days at the gym are focused on upper body weight training and overall stretching.

You've given me a good reminder to not overdo things, which is a long time habit I continually struggle with. I think it's my way of convincing myself I'm not really getting older.

 

[Mojo333]

It's tough I know.
Alot has happened for you since May.
You are going to get this fixed and heal up..and it will be remarkable how young you will feel.
It's all this convalescing and that first out of surgery glimpse into potty chairs and walking aids, etc...
that has your male sensibilities kicking into "I'll show you" mode.
Don't make me holler at you...
Ask @Bone-obo or @SaraK ..
I will do it.
Just want everyone OK!

 

[SaraK]

But will @TerryB_TX listen any more than us?

 

[TerryB_TX]

Just had the final pre-op meeting with my revision surgeon. All is good to go for my surgery scheduled for Monday, August 20. He is planning to do an anterior approach for my revision. My original surgery was posterior. I trust his skills and want him to use whatever approach works best for him.

We briefly discussed ceramic versus polyethylene liners. He seems to prefer the ceramic in younger patients for longevity, but felt that the plastic liner by DePuy, already in place, is very good and likely would have adequate life. The decision of which to use will be made during the surgery based on fit with old/new components. No concerns on my part as either should be fine, as Josephine said in earlier posts.

We again talked through the issue of osseo-integration. Paraphrasing his description of the process and timing:
Stage one is stem fixation as bone bridges to, and fixes the stem. He said about 6 weeks for this process. Avoiding stem movement relative to the femur is critical during this stage. This is followed by stage two integration in which the bond is reinforced and strengthened by the growth of stronger "columnar" structure bone. This process can take up to a year. All seems fairly consistent with the BoneSmart library information.

Once again, I'm up in the air regarding the Celebrex following surgery. I believe my surgeon's routine is 6 weeks at 2x200 mg/day. Objective is to suppress heterotopic ossification (HO). The decision to take or not take the Celebrex is a risk based decision... risk of negatively impacting stem fixation versus risk of HO, which is higher for men and, if I interpreted literature correctly, for multiple surgeries like a revision. I believe the consequences of another failed integration are more severe than the consequences of HO. Besides, after one year, I had no HO with the first surgery, so perhaps I may not be predisposed. I believe I read, however, that the mean time for HO to appear is about one year. Again, unsure what I want to do. Maybe I could split the difference and just take half the dose for a shortened period of time (a week or two). I don't mean to resurrect an issue which has already been well debated on this forum. @Josephine , who's opinion I greatly respect, has already weighed in. I just really feel uncomfortable overriding the directions of my surgeon, whom I also trust.

 

[Layla]

Hi Terry,
Just an FYI, Josephine is away from the forum for several days. Hopefully she'll be able to address
your question before Monday. Next week at this time you'll be on your healing journey. All the research behind you and on your way to perfect healing.....that will be my prayer.
Wishing you comfort and peace of mind for the interim.
@TerryB_TX

 

[TerryB_TX]

Thank you @Layla . Not necessarily looking for a response from Josephine and certainly don’t want to interrupt her time away. Probably shouldn’t have tagged her. Her position is well documented and I respect her opinion. Just debating in my own mind the pros and cons, including the consequences of HO, trying to get a better understanding of the risk.

Looking forward to getting all this behind me. I know there will be ups and downs between now and the time I feel confident that this revision is a success. Appreciate your well wishes and continuing support along he way.

 

[Mojo333]

Let's get this show on the road, Terry
You deserve to get this right and get on with your life.
Will be thinking of you Monday!

 

[Hipster63]

Best of luck to you Terry. We share the same Dr. and I too have faith and a lot of trust in him. I look forward to reading your recovery posts.